Exploring accessibility issues of a public building for the mobility impaired. Case study: interstate bus terminal (ISBT), Vijayawada,India*

Right to access in the built environment creates equal and nondiscriminatory opportunities to a person with disabilities in order to move freely around and interact positively without hindrance and barriers. The objective of the study is to understand the existing accessibility related issues and implementation of guidelines and standards for public buildings. The technical verification using onsite and offsite access audit format for current provision of facilities in the internal and external environment has been carried out with the format prepared in reference to Central Public Works Department (CPWD) accessibility guidelines for mobility impaired and elderly and American Disability Act (ADA) guidelines. The access audit format included parameters like accessibility, safety, security, comfort and convenience and it addresses the barriers faced by wheel chair users, people with crutches, prosthetics and with non-assistive devices. The study addressed accessibility compliance in three zones of the building with initiation from parking area zone, inside the building, and area outside the building premises. The findings highlight the environmental barriers encountered by mobility impaired people and represented graphically in the layout plan and physical effort required to overcome the challenges in the built environment. The overall accessibility compliance is 42% in the interstate bus terminal.

• Implications for rehabilitation

• The study identifies the environmental limitations, human and technologically facilitators with the help of Central Public Works Department (CPWD) and American Disability Act (ADA) guidelines (1990).

• It highlights barriers for mobility-impaired users, by demonstrating in a spatial layout and the means to facilitate easy access with minimal frustration, stress and with less physical effort.

• It demonstrates the need for preparation of separate guidelines for making the existing types of buildings to be access and disabled-friendly.

• New accessibility guidelines shall be prepared by incorporating concepts like such as relative accessibility into new bus terminal buildings.

• Guidelines help the disabled in the process of rehabilitation and develop inclusiveness not rather than alienation.

     

Low vision and mobility scooters: the experiences of individuals with low vision who use mobility scooters

Abstract

Purpose: Older adults with low vision are a growing population with rehabilitation needs including support with community mobility to enable community participation. Some older adults with low vision choose to use mobility scooters to mobilize within their community, but there is limited research about the use by people with low vision. This paper describes a pilot study and asks the question: what are the experiences of persons with low vision who use mobility scooters?

Methods: This study gathered the experiences of four participants with low vision, aged 51 and over, who regularly use mobility scooters. Diverse methods were used including a go-along, a semi-structured interview and a new measure of functional vision for mobility called the vision-related outcomes in orientation and mobility (VROOM).

Findings: Four themes were found to describe experiences: autonomy and well-being, accessibility, community interactions and self-regulation.

Discussion and implications: This study was a pilot for a larger study examining self-regulation in scooter users. However, as roles emerge for health professionals and scooters, the findings also provide evidence to inform practice, because it demonstrates the complex meaning and influences on performance involved in low vision mobility scooter use.

• Implications for rehabilitation

• Scooter use supports autonomy and well-being and community connections for individuals with both mobility and visual impairments.

• Low vision scooter users demonstrate self-regulation of their scooter use to manage both their visual and environmental limitations.

• Issues of accessibility experienced by this sample affect a wider community of footpath users, emphasizing the need for councils to address inadequate infrastructure.

• Rehabilitators can support their low vision clients’ scooter use by acknowledging issues of accessibility and promoting self-regulation strategies to manage risks and barriers.

     

Impact of environmental factors in home rehabilitation – a qualitative study from the perspective of older persons using the International Classification of Functioning,Disability and Health to describe facilitators and barriers

Purpose: The aim of this study was to explore older people’s experience of environmental factors that impact on their activity and participation in home rehabilitation. Method: Older people aged between 68 and 93 years and receiving home rehabilitation were interviewed. A qualitative content analysis was performed on the interview text using the predetermined structure of the International Classification of Functioning, Disability and Health (ICF) environmental domain. The text was linked to the closest ICF category. Results: The results identified environmental facilitators and barriers that influenced activity and participation among older people receiving home rehabilitation. Approaches that provided a facilitative environment were access to assistive products and technologies, alterations to the physical environment, social support and relationships, and adjusted health and social care services. Conclusions: A qualitative study using ICF-listed environmental factors contributed a holistic view of facilitators and barriers in home rehabilitation for older people. Awareness of the importance of the impact of the social environment on activities and participation could improve home rehabilitation services for older people. The study represents an important step towards a holistic approach using the ICF, which aims to enable all health care professionals to describe, plan and evaluate rehabilitation services together with older people across the health and social care sectors.

Implications for Rehabilitation

• Environmental factors can be considered as obstacles or facilitators depending on each unique individual’s need.

• In a relatively small sample, this study shows the importance of the impact of the social environment on activities and participation among older people receiving home rehabilitation.

• Using ICF “linking rules” to link environmental factors as facilitators or barriers reported by older people can identify potentially important areas in home rehabilitation service described in the ICF categories. This can facilitate to improve rehabilitation service for older people.

• Reveals health care professionals as one central environmental factor for older people’s rehabilitation.

     

Addressing challenges for youths with mobility devices in winter conditions

Purpose: Winter-related research about the experience of navigating in the urban context has mostly focused on the elderly population with physical disabilities. The aim of this project was to explore potential design solutions to enhance young people’s mobility devices and the built environment to improve accessibility and participation in winter.

Methods: A multi-method qualitative design process included the following steps: (1) in-depth interviews; (2) photo elicitation; (3) individual co-design sessions; and (4) group co-design sessions (i.e., focus group). The participants were 13 youths (nine males and four females), aged 12–21, who used a wheelchair (12 power chair users and one manual wheelchair), for some with their parents, others without their parents, according to the parents' willingness to participate or not in the study (n?=?13). The first two authors conducted group co-design sessions with mechanical engineers and therapists/clinicians in two Canadian cities to discuss the feasibility of the designs.

Results (findings): The youths and their parents reported different winter-related challenges and proposed specific design solutions to enhance their participation and inclusion in winter activities. Seven of these designs were presented at two group co-design sessions of therapists/clinicians and engineers. Two designs were found to be feasible: (1) a traction device for wheelchairs in snow and (2) a mat made of rollers to clean snow and dirt from tires. The results of this research highlight the frustrations and challenges youths who use wheelchairs encounter in winter and a need for new solutions to ensure greater accessibility in winter.

Conclusions: Therapists/clinicians and designers should address winter-related accessibility problems in areas with abundant snow.

• Implications for Rehabilitation

• Several studies show that current urban contexts do not necessarily respond accurately to the needs of individuals with limited mobility.

• Winter-related research about the experience of navigating in the urban context is limited and has mostly focused on the elderly population with physical disabilities.

• Our results clearly show that youth who use mobility devices want to be able to get around in the snow, wander outdoors, play and enjoy social participation in activities with their peers and friends.

• Our findings provide a starting point for the development of additional studies to seek a better understanding of the person–environment interaction in winter conditions, with tangible results in the form of better design solutions.

• Clinicians and designers must address such issues in northern countries and areas where snow is abundant.

     

Understanding factors that influence participation in physical activity among people with a neuromusculoskeletal condition: a review of qualitative studies

Purpose: This review aims to describe the factors that influence participation in physical activity (PA) in people with neuromusculoskeletal (NMS) conditions. Methods: A systematic search of six databases was conducted. Articles were included if the study qualitatively explored factors that influence participation in PA by individuals with a NMS condition. Fifteen peer-reviewed articles published between 2003 and 2013 were analysed for common themes and critically appraised. Results: Results were categorised using the International Classification of Functioning, Disability and Health framework. The most common demotivators reported for the three areas of functioning, body function and structures, activities and participation were lack of walking balance, muscle weakness, pain, stiffness, bladder and blower problems, depression, thermoregulation and fear of injury. Fluctuating symptoms and fatigue were mentioned as demotivators in all of the progressive conditions. Maintaining independence, function and weight, and the prevention of secondary conditions were the leading motivators reported in this domain. Most common environmental barriers include accessibility, costs, transport and insufficient information and knowledge from health professionals. Social support is a consistent determinate of PA and is reported as a facilitator in every study. The most common personal demotivators include lack of motivation, feelings of self-consciousness and embarrassment in public, anxiety, frustration and anger. Personal motivators include goal setting and achieving, enjoyment, feeling good, feeling “normal”, motivation and optimism, redefining self and escapism from everyday boundaries. Conclusions: Individuals with NMS conditions report complex common barriers, facilitators, demotivators and motivators to participation in PA. The way these factors influence participation in PA is unique to the individual; therefore, it is necessary to adopt an individually tailored approach when designing interventions.

• Implications for Rehabilitation

• Individuals with neuromusculoskeletal conditions report common factors that influence participation in physical activity.

• It is the characteristics, attitude and beliefs of an individual that determine the way in which these factors influence participation in physical activity.

• Health professionals should be guided by the International Classification of Functioning, Disability and Health framework when assessing individuals, as the model will ensure all major factors of interest with regard to disability and physical activity behaviour are considered.

• Interventions to promote participation in physical activity in people with neuromusculoskeletal conditions require an individual approach that facilitates the assessment and management of an individual’s barriers to physical activity.

• A multi-disciplinary approach may be required to address factors that influence participation in physical activity. Health professionals must be informed about other areas of expertise and draw on this when necessary.

     

Health disparities among workers and nonworkers with functional limitations: implications for improving employment in the United States

Purpose: The aim of this study was to compare workers and nonworkers who reported mild, moderate, and severe/complete functional limitations to identify disparities in 19 health and social indicators. Method: Using the International Classification of Functioning, Disability and Health as our conceptual framework, we analyzed data from the combined 2000–2008 National Health Interview Survey, comparing workers and nonworkers by severity of functional limitations, as measured by the FL12 Scale of Functional Limitation Severity. Results: Only 9.5% of people reporting moderate/severe functional limitations worked. Although not without exception, not working and severity of functional limitation were associated with poorer health outcomes, with nonworkers reporting severe/complete limitations having least optimal health. Prevalence of chronic conditions was associated with level of functional limitation severity, with the strongest associations among nonworkers. Conclusions: By focusing exclusively on people with functional limitations, we were better able to examine factors contributing to health and participation of workers and nonworkers. People who worked and had moderate or severe/complete limitations often did so while reporting poor health. With improved access to health care, health promotion activities, and other support systems, the quality of life and likelihood of work participation of people with greater functional limitations might also be improved.

Implications for Rehabilitation

• Improving access to health care, health promotion activities, and other support systems may increase the quality of life and likelihood of work participation of people with moderate or severe/complete limitations.

• Specifically addressing health behaviors among workers and nonworkers with moderate and severe/complete functional limitations in the course of rehabilitation may improve both work participation and job retention.

• Workers and nonworkers with mild, moderate, and severe/complete activity limitations exhibit different patterns of health and participation requiring carefully crafted intervention strategies

• Consistent management of chronic health conditions and chronic pain may improve the likelihood of work participation and retention in the workforce among adults with moderate and severe/complete functional limitations.

     

Adolescents with disabilities participate in the shopping mall: facilitators and barriers framed according to the ICF

Purpose: Community participation is restricted for youth with disabilities. The mall is an important gathering place where adolescents often socialise and develop community living skills, yet participation may be restricted. The aim of this study was to evaluate the facilitators and barriers to participation in a shopping mall through the perspectives of adolescents with disabilities.

Method: Semi-structured individual interviews were conducted with adolescents aged 12–19 years with a physical and/or sensory disability. Audio recordings were transcribed verbatim and coded following a template analysis using the International Classification of Functioning Disability and Health (ICF).

Results: Eleven youth (six females, mean age?=?17.0 years) participated. Medical conditions included visual impairment, hearing impairment, cerebral palsy, hemiplegia, osteogenesis imperfecta and congenital amputations. Six themes were identified by the adolescents: what the shopping mall means to me, physical environment, transportation, social factors, attitudes and the person. The majority of themes mapped to the ICF’s ‘environmental factors’.

Conclusions: Facilitators and barriers identified were either generic or disability-specific, implying that some modifications to shopping malls may be beneficial across disability types. Changes made to the physical, social and attitudinal environment are required to enable full participation of youth with disabilities within a shopping mall and other built environments of high public access.

• Implications for Rehabilitation

• The meaning of the shopping mall according to youth with disabilities includes socialisation, shopping, getting out of the home and employment.

• The majority of themes mapped to ‘environmental factors’ indicating that most obstacles to participation are caused by environmental barriers.

• Facilitators and barriers identified were either generic or disability-specific implying that some modifications to shopping malls may be beneficial across disability types.

• Changes made to the physical, social and attitudinal environment are required to enable full participation of youth with disabilities within a shopping mall.

     

Associations between neighbourhood characteristics and community mobility in older adults with chronic health conditions

Purpose: To explore associations between perceptions of neighbourhood built and social characteristics and satisfaction with community mobility in older adults with chronic health conditions. Method: Two hundred and thirty-seven community-dwelling adults aged 60 years or more with one or more of arthritis (osteoarthritis or rheumatoid arthritis), chronic obstructive pulmonary disease, diabetes or heart disease completed a cross-sectional, mailed survey. The survey addressed community mobility and 11 neighbourhood characteristics: amenities (three types), problems (six), social cohesion and safety. Analysis involved logistic regression modeling for each neighbourhood characteristic. Results: Satisfaction with community mobility was associated with perception of no traffic problems (OR?=?3.0, 95% CI?=?1.4–6.2, p?≤?0.05) and neighbourhood safety (OR?=?3.4, 95% CI?=?1.2–9.8, p?≤?0.05), adjusted for age, ability to walk several blocks and depressive symptoms.

Conclusion: Satisfaction with community mobility is associated with neighbourhood safety and no traffic problems among older adults with chronic conditions. While further research is needed to explore these neighbourhood characteristics in more detail and to examine causation, addressing these neighbourhood characteristics in health services or community initiatives may help promote community mobility in this population.

• Implications for Rehabilitation

• Community mobility, or the ability to move about one’s community, is a key aspect of participation that enables other aspects of community participation.

• Good community mobility is associated with perception of no traffic problems and neighbourhood safety among older adults.

• Considering and addressing a broad range of environmental influences has the potential to improve community mobility in older adults, beyond traditional approaches.

• Health professionals can work with clients to develop strategies to avoid traffic and safety problems and can work with communities to develop safe spaces within neighbourhoods, to improve community mobility in older adults.

     

Weather,disability, vulnerability,and resilience: exploring how youth with physical disabilities experience winter

Abstract

Purpose: Having a mobility-related disability can create numerous challenges in navigating the physical and built environment, especially during winter. Such weather-related challenges can be a significant barrier to participation in everyday activities and are linked with increased physical and psychological morbidities. Unfortunately, mobility research – especially among youth – has often overlooked the effects of winter weather. Methods: This study explores the experiences of daily activities during Canadian winter among a purposive sample of youth, aged 15–22, who have a physical disability requiring the use of a mobility device. The researchers applied a qualitative design, including 12 in-depth interviews. Results: Our findings show that youth encounter several vulnerabilities to participating in social and recreational activities in winter, including: (1) physical barriers and social spatial exclusion; (2) health and safety concerns; and (3) psychosocial issues (i.e. worry, isolation and dependence). Youth also discussed several strategies for adapting to barriers and enhancing their participation during winter, including: (1) wheelchair maintenance; (2) awareness of surroundings; (3) practice using mobility devices and planning; and (4) keeping busy and active. Conclusions: Youth who use a mobility device are vulnerable to health and safety risks and isolation during the winter, but they also display signs of resilience.

• Implications for Rehabilitation

• Clinicians should ensure that youth who are new to using their mobility device are properly trained in how to use it.

• Service providers should offer a winter survival guide to youth who use a mobility device.

• Clinicians should be taught to recognize signs of loneliness, isolation and depression, and provide a list of local resources and activities during the winter.

• Rehabilitation engineers should focus their efforts on adapting mobility devices to enhance the safety of youth.

     

Realizing the potential of accessible ICTs in developing countries

Purpose: To raise the awareness of policy makers, economic development practitioners, and service providers about the importance of making information and communication technology (ICT) based international economic development in low- and middle-income countries inclusive of people with disabilities and to discuss the role and importance of addressing the complete ICT and assistive technology (AT) ecosystem to ensure sustainable, scalable, and affordable access to ICTs and ICT-based programs. Method: This commentary piece draws upon recent literature and practice cases to examine the role of accessible ICTs in international development. Results: Accessible ICTs can enhance economic participation and prevent exclusion from participation in international development programs. Access to and use of accessible technologies are largely determined by the ecosystem in which they exist and can be enhanced or hindered by government policy and legislation and the quality of the service delivery systems and financing mechanisms. Conclusions: People with disabilities in developing countries face daunting barriers to socioeconomic participation. Accessible ICTs can eliminate or mitigate some of these barriers. However, technology advancements do not solely promote penetration, affordability, or scalability of ICT-based development for persons with disabilities. A comprehensive ecosystem approach can help in developing sustainable mechanisms for access, affordability, and availability.

Implications for Rehabilitation

• Accessible ICTs are unavailable to the majority of people with disabilities living in low- and middle-income countries thus posing barriers to socioeconomic participation and ICT enabled social and economic development programs (ICT4D).

• Availability of and access to ICT is determined by the nature and components (individual, social, financial, and government actors and systems) of its ecosystem.

• The promise of ICTs for people with disabilities cannot be realized in low- and middle-income countries without supportive legislation, policy, infrastructure and financing.

• The ICT ecosystem will promote successful outcomes when its stakeholders, policy structures, and resources align to strengthen and support one another.

     

Adaptive invention: independence and mobility through modifications

Background: Stroke is a leading cause of disability that limits everyday activities and reduces social participation. Provision of assistive devices helps to achieve independence and social inclusion. However, due to limited resources or a lack of suited objects for their needs, individuals with disabilities in low and middle income countries (LMIC) often do not have access to assistive devices. This has resulted in the creation of purpose built innovative solutions.

Methodology and case content: This paper uses a single case derived from a larger ethnographic study of stroke survivors in rural Malaysia to demonstrate the role of assistive devices in shaping stroke recovery and how existing structures can be modified. Second, the concept of affordances in relation to structures within the environment, issues of affordability and accessibility of assistive devices for individuals in LMIC are discussed.

Findings and conclusions: Stroke recovery involves adapting to new limitations and discovering the support necessary to live life. These changes are influenced by a range of environmental factors. Healthcare professionals need to support stroke patients in identifying challenges and work to find innovative ways to address them. Stroke survivors may benefit from the use of an assistive device beyond its clinical function to participate purposefully in activities of daily living.

• Implications for Rehabilitation

• Stroke is a cause of disability that limits everyday activities and reduces social participation.

• Assistive devices help achieve independence, social inclusion and shape stroke recovery.

• Individuals with disabilities in low and middle income countries often do not have access to assistive devices and resort to innovative solutions that are purpose built.

• Stroke recovery involves adapting to new limitations and discovering the support necessary to live life as best as possible.

     

The impact of mobility assistive technology devices on participation for individuals with disabilities

Aim: This study aims to address the gap in research and contribute to the body of knowledge on the perspectives assistive technology device users have toward their devices. Method: Mixed methods were used to better understand the impact of mobility assistive technology devices (MATDs) on participation for individuals with disabilities. The Functional Mobility Assessment was administered in conjunction with two qualitative questions developed by the research team allowing participants to expound on the impact of their MATD experience. Participants were recruited online via the National Spinal Cord Injury Association website and in-person at Abilities Expo in Atlanta, Georgia, and the International Seating Symposium in Nashville, Tennessee. Results: Results are consistent with findings from prior research regarding accessibility for individuals with disabilities. Corresponding findings were found in both the quantitative and qualitative data and are categorized into several major themes: environment (indoor and outdoor), surface heights, transportation, dependence, independence, quality of life and participation. Conclusion: Quantitative data from this study indicate that users of MATD are satisfied with the way in which their devices enable maneuvering indoors, while qualitative data suggest otherwise. Implications for healthcare practitioners are described and future recommendations are provided.

• Implications for Rehabilitation

• Healthcare professionals should advocate for proper mobility assistive technology devices (MATDs) for their patients in order to enable increased independence, safety and efficiency.

• Healthcare professionals must be cognizant of the impact of the environment and/or environmental barriers when prescribing MATD.

• Additional areas of interest for future research may include investigating the impact of MATD in association with date of onset of disability, according to diagnoses, or specific to length of time since acquiring the device.

     

Activities and participation of children with cerebral palsy: parent perspectives

Abstract

Purpose: To explore parents’ views of the activities and participation of children with cerebral palsy (CP) with a range of communicative abilities and the factors (personal and environmental) that influenced these. Methods: Thirteen parents of children with CP aged 4—9 years participated in semi—structured individual interviews. Interviews were recorded, transcribed and analysed thematically. Identified codes and themes were mapped to the domains of the International Classification of Functioning, Disability and Health — Children and Youth Version (ICF-CY). Results: Parents’ responses reflected all ICF-CY domains comprising activity, participation and environmental factors. Codes were primarily mapped to the domains learning and applying knowledge, communication, mobility and interpersonal interactions and relationships. Key barriers identified included aspects of parents’ own interactions with their child (e.g. not offering choices), unfamiliar people and settings, negative attitudes of others and children’s frustration. Facilitators included support received from the child’s family and school, being amongst children, having a familiar routine and the child’s positive disposition. Conclusions: Despite the barriers experienced, children participated in a range of activities. Parents placed importance on communication and its influence on children’s independence, behaviour and relationships. Barriers and facilitators identified highlight aspects of the environment that could be modified through intervention to enhance communication and participation.

• Implications for Rehabilitation

• Children’s activities and participation were largely related to early learning tasks (e.g. literacy), communication, mobility and interactions.

• Intervention aimed at improving activities and participation may address the various child, impairment, social and environment factors identified here as impacting on activities and participation (e.g. the child’s personal characteristics, communication and physical impairments, the support and attitudes of others and the familiarity of the environment).

• Therapists will need to consider (and manage) the potential negative impact communication deficits may have on children’s behaviour, independence and social skills which may in turn detrimentally impact on activity and participation.

     

Assessment of activity limitations and participation restrictions with persons with chronic fatigue syndrome: a systematic review

Abstract

Purpose: To summarize measurement instruments used to evaluate activity limitations and participation restrictions in patients with chronic fatigue syndrome (CFS) and review the psychometric properties of these instruments. Method: General information of all included measurement instruments was extracted. The methodological quality was evaluated using the COSMIN checklist. Results of the measurement properties were rated based on the quality criteria of Terwee et?al. Finally, overall quality was defined per psychometric property and measurement instrument by use of the quality criteria by Schellingerhout et?al. Results: A total of 68 articles were identified of which eight evaluated the psychometric properties of a measurement instrument assessing activity limitations and participation restrictions. One disease-specific and 37 generic measurement instruments were found. Limited evidence was found for the psychometric properties and clinical usability of these instruments. However, the CFS-activities and participation questionnaire (APQ) is a disease-specific instrument with moderate content and construct validity. Conclusion: The psychometric properties of the reviewed measurement instruments to evaluate activity limitations and participation restrictions are not sufficiently evaluated. Future research is needed to evaluate the psychometric properties of the measurement instruments, including the other properties of the CFS-APQ. If it is necessary to use a measurement instrument, the CFS-APQ is recommended.

• Implications for Rehabilitation

• Chronic fatigue syndrome (CFS).

• Chronic fatigue syndrome causes activity limitations and participation restrictions in one or more areas of life.

• Standardized, reliable and valid measurement instruments are necessary to identify these limitations and restrictions.

• Currently, no measurement instrument is sufficiently evaluated with persons with CFS.

• If a measurement instrument is needed to identify activity limitations and participation restrictions with persons with CFS, it is recommended to use the CFS-APQ in clinical practice and scientific research.

     

Optimising leisure participation: a pilot intervention study for adolescents with physical impairments

Purpose: To assess the feasibility of an intervention to improve participation in leisure activities of adolescents with physical impairments by changing aspects of the activity or environment. Methods: A pre-test/post-test pilot study of a multi-strategy intervention was used to explore the effectiveness of the strategies and to determine whether the intervention was practical to apply in a community setting. The intervention involved establishing adolescent and family focused goals, measuring and addressing environmental barriers and building activity performance skills. The Goal Attainment Scale (GAS) and the Canadian Occupational Performance Measure measured outcomes. Results: Eight participants (aged 12–19 years; five males) with physical disabilities set participation goals using a structured approach. Analysis of personal and environmental barriers and facilitators for participation guided the choice of intervention strategies to support goal attainment. The natural environment, government policies and availability of transport were identified as the most frequent barriers to participation in leisure. Support to secure appropriate devices to enable participation was commonly required. As a group, attainment of 12 of 17 GAS goals, and progress on four more goals, was demonstrated. Conclusions: The intervention model was applicable and practical to use in a community therapy setting and the majority of the participation goals set were achieved.

• Implications for Rehabilitation

• This ICF-based intervention model was applicable and practical to use in a community therapy setting.

• The majority of the adolescent’s leisure participation goals were achieved following engagement in the multi-strategy intervention.

• Adolescents with sufficient communication skills (CFCS Levels I–III) benefited from a group-based intervention in addition to individualised support.

     

International classification of functioning,disability and health in children with cerebral palsy

Purpose: We intended to describe how concepts from recent models of disability have been studied for evaluation of children with cerebral palsy (CP) and their clinical implications. Method: We revised studies that focused on the components of the International Classification of Functioning, Disability and Health (ICF) in children with CP. Results: Researchers have reported that children with CP exhibit impairments in various body functions/structures, limitations in functional activities performance and experience poorer participation outcomes than their typical peers. Moreover, it has been showed that participation of children with CP was affected by environmental factors. Conclusion: Therefore, evaluation and rehabilitation processes should be focused on the quality of life improvement by emphasizing what a child can and wants to execute within the environment. Also, environmental factors should be recognized so that barriers could be minimized and adaptations to the environment achieved. However, few studies have verified the interrelationship between contextual factors and the functioning and disability domains in children with CP. This would allow us to know about approaches specifically designed for these children’s needs.

Implications for Rehabilitation

• Cerebral palsy is a disabling disease which impacts in body structures and functions, functional activities performance and social participation.

• ICF is a model of disability that focuses on the integration of these three dimensions.

• The knowledge about the concepts of ICF applied in children with CP allows an evidence-based practice.

     

Web accessibility standards and disability: developing critical perspectives on accessibility

Abstract

Purpose: Currently, dominant web accessibility standards do not respect disability as a complex and culturally contingent interaction; recognizing that disability is a variable, contrary and political power relation, rather than a biological limit. Against this background there is clear scope to broaden the ways in which accessibility standards are understood, developed and applied. Methods: Commentary. Results: The values that shape and are shaped by legislation promote universal, statistical and automated approaches to web accessibility. This results in web accessibility standards conveying powerful norms fixing the relationship between technology and disability, irrespective of geographical, social, technological or cultural diversity. Conclusions: Web accessibility standards are designed to enact universal principles; however, they express partial and biopolitical understandings of the relation between disability and technology. These values can be limiting, and potentially counter-productive, for example, for the majority of disabled people in the “Global South” where different contexts constitute different disabilities and different experiences of web access. To create more robust, accessible outcomes for disabled people, research and standards practice should diversify to embrace more interactional accounts of disability in different settings.

• Implications for Rehabilitation

• Creating accessible experiences is an essential aspect of rehabilitation.

• Web standards promote universal accessibility as a property of an online resource or service. This undervalues the importance of the user’s intentions, expertize, their context, and the complex social and cultural nature of disability.

• Standardized, universal approaches to web accessibility may lead to counterproductive outcomes for disabled people whose impairments and circumstances do not meet Western disability and accessibility norms.

• Accessible experiences for rehabilitation can be enhanced through an additional focus on holistic approaches to accessibility blending digital and physical solutions, the use of BS 8878 and mixed-method approaches to accessibility benchmarking.

• Web standards and accessibility conformance should be considered together with user input and the recognition and development of local accessibility and rehabilitation expertize.

     

Disability in post-earthquake Haiti: prevalence and inequality in access to services

Abstract

Purpose: To assess the prevalence of disability and service needs in post-earthquake Haiti, and to compare the inclusion and living conditions of people with disabilities to those without disabilities. Methods: A population-based prevalence survey of disability was undertaken in 2012 in Port-au-Prince region, which was at the centre of the earthquake in 2010. Sixty clusters of 50 people aged 5?+?years were selected with probability proportionate to size sampling and screened for disability (Washington Group short set questionnaire). A case-control study was undertaken, nested within the survey, matching cases to controls by age, gender and cluster. There was additional case finding to identify further children with disabilities. Information was collected on: socioeconomic status, education, livelihood, health, activities, participation and barriers. Results: The prevalence of disability was 4.1% (3.4–4.7%) across 3132 eligible individuals. The earthquake was the second leading cause of disability. Disability was more common with increasing age, but unrelated to poverty. Large gaps existed in access of services for people with disabilities. Adults with disabilities were less likely to be literate or work and more likely to visit health services than adults without disabilities. Children with disabilities were less likely to be currently enrolled at school compared to controls. Children and adults with disabilities reported more activity limitations and participation restriction. Conclusion: Further focus is needed to improve inclusion of people with disabilities in post-earthquake Haiti to ensure that their rights are fulfilled.

• Implications for Rehabilitation

• Almost one in six households in this region of Haiti included a person with a disability, and the earthquake was the second leading cause of disability.

• Fewer than half of people who reported needing medical rehabilitation had received this service.

• The leading reported barriers to the uptake of health services included financial constraints (50%) and difficulties with transport (40%).

• People with disabilities did not participate equally in education or employment and had poorer access to health care.

     

Using intersectionality to explore experiences of disability and HIV among women and men in Zambia

Abstract

Purpose: Little is known about the experiences of people with disabilities (PWD) who live with HIV. Existing research largely assumes a “double burden” approach, which views HIV as doubling the load for people already burdened by disability. Intersectionality (a dynamic process of converging systems of relationships) offers an alternative approach for understanding differences in experience. This study uses an intersectional approach to explore the experiences of PWD in Zambia who have become HIV-positive. Methods: We conducted semi-structured, in depth interviews with 21 PWD who live with HIV in Zambia (12 women, 9 men). Participants had various impairments (visual, hearing, mobility, intellectual). Interviews were conducted to meet participants’ accessibility preferences. Results: Our intersectional analysis demonstrates the dynamic and situational emergent meanings and consequences for PWD who are living with HIV related to: (1) meanings of HIV and disability linked with time and trajectory; (2) oppression and negotiation related to accessing health services and (3) social roles and relationships. Three case studies illustrate these circumstances. Conclusions: Intersectionality offers a complementary approach for examining the complex interrelationship among HIV, disability, gender and time among PWD living with HIV. Findings illustrate directions for improved services and policies for this important group.

• Implications for Rehabilitation

• Rehabilitation services need to take a cross-disability (multiple disabilities) approach working with people living with HIV and disability.

• Rehabilitation, as illustrated by a CBR approach, needs to include services that will facilitate not only health, but education, jobs and housing for people living with HIV and disability.

• Rehabilitation needs to make more direct connections with Zambia social service sector to help address the fluctuating experience of living with HIV and disability.